Applying Andersen's Behavioural Model to Oral Health Quality of Life

Andersen's (1995) revised behavioural model provides a framework for understanding the factors which influence individual's dental practices, use of dental services and oral health outcomes. To date, there have been few studies that have explicitly tested the model using empirical evidence. The aim of this study was to test the model and to examine the direct and mediated pathways between predisposing characteristics, enabling resources, need, health behaviour and use of services and perceived oral health outcomes.

Methods:

The model was tested in a general population sample using data from the UK adult dental health survey (N = 3815) using the two-stage process of structural equation modelling (SEM).

Results:

SEM indicated support in line with the hypotheses within the model; enabling resources (oral health promotion advice, type of dental service, finding NHS treatment expensive, dental anxiety) predicted need (number of decayed or unsound teeth and perceived treatment need); enabling resources and need predicted personal health practices and use of services (frequency of toothbrushing, dental attendance, attendance orientation) which, in turn, predicted perceived oral health outcomes (oral health quality of life and satisfaction with appearance). Both enabling resources and need also predicted oral health outcomes. The impact of predisposing factors (social class, qualifications, income) on need, personal health practices and use of services, and oral health outcomes was indirect; that is, mediated by intervening factors. In the final model, 29, 33, 49 and 26% of the variance was accounted for in enabling resources, need, personal health practices and use of services and oral health outcomes respectively.

Conclusions:

The results provide support for Andersen's conceptual model as applied to dental practices, use of dental services and oral health quality of life. Further conceptual development of the model is discussed, and theoretical and methodological issues in oral health quality of life research highlighted.